| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
741 |
488 |
$62K |
| D1110 |
Prophylaxis - adult |
1,698 |
1,641 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
653 |
377 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,350 |
1,307 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,849 |
1,792 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,974 |
2,856 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,213 |
1,165 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
733 |
711 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,787 |
2,286 |
$16K |
| D4341 |
|
135 |
51 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
132 |
91 |
$9K |
| D1120 |
Prophylaxis - child |
110 |
110 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
203 |
201 |
$4K |
| D0330 |
Panoramic radiographic image |
53 |
47 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
25 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$818.80 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$378.41 |
| D0270 |
|
12 |
12 |
$88.82 |